Provider Demographics
NPI:1851754998
Name:VAKILI, VESAL
Entity Type:Individual
Prefix:
First Name:VESAL
Middle Name:
Last Name:VAKILI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 MARITIME DR
Mailing Address - Street 2:110
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3661
Mailing Address - Country:US
Mailing Address - Phone:916-600-1198
Mailing Address - Fax:
Practice Address - Street 1:2358 MARITIME DR
Practice Address - Street 2:110
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3661
Practice Address - Country:US
Practice Address - Phone:916-600-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst